WASHINGTON — While battlefield injury, musculoskeletal injury and mental disorders top the list of reasons troops are medically evacuated from military theaters of operation, a variety of other conditions can force the removal of patients from battle areas.

Historically, dermatologic issues have always been on the list, and the conflicts in Iraq and Afghanistan were no exceptions.

A study conducted near the height of military action in operations Enduring Freedom and Iraqi Freedom noted that skin conditions ranging from hives and dermatitis to benign moles and cancerous skin lesions are among the most common diagnoses among military personnel who were evacuated from combat zones. 1

The study, published in a 2009 issue of the Archives of Dermatology, further noted, “Skin diseases during wartime are exacerbated by sun exposure, temperature and humidity extremes, native diseases, insects, crowded living conditions, difficulty maintaining personal hygiene and chafing and sweating caused by body armor, helmets and other protective gear,” adding, “In tropical and subtropical climates, skin diseases have accounted for more than half of the days lost by frontline units.”

Yet, dealing with those issues has resulted in significant advances in diagnosis and treatment by military dermatologists, including the growing use of telemedicine.

“It is Tri-service and … there has even been NATO involvement in that as well,” Col. Daniel J. Schissel, the Army Surgeon General’s consultant on dermatology told U.S. Medicine.

The study also underscored the value of dermatology expertise. Researchers examined data from Jan. 1, 2003, through Dec. 31, 2006, from aeromedical evacuation records and the military’s electronic medical records system, finding that a total of 170 patients had been evacuated from the combat zone for ill-defined dermatologic diseases.

The diagnoses used to justify the evacuation of patients with skin diseases were generated mostly by nondermatologists, according to study authors who suggested that vague diagnoses indicated that “the clinician who ordered the evacuation was uncertain of the patient’s cutaneous condition.”

Evaluated post-evacuation by a board-certified dermatologist, the servicemembers were given a defined diagnosis in nearly all cases. Dermatitis, benign melanocytic nevus, malignant neoplasms, benign neoplasms, urticaria, and a group of nonspecific diagnoses were the most common post-evacuation diagnoses. That study concluded that improving diagnostic accuracy and treatment plans via teledermatology were possible methods to reduce evacuations.